A macular hole is a hole in the central part of the retina which is most important for vision. The retina is the innermost light sensitive layer of the eye akin to a film of a camera where the image is formed.
Macular hole is more common in those over 50 years of age and female gender
Macular hole progresses through 4 stages (which are graded onn OCT scan images ). The vision is poorer in stages 3 and 4 compared to stages 1 and 2
Diagnosis is made by the ophthalmologist on a clinical examination after dilating eyes and viewing the retina under magnification with an appropriate lens . Since the hole may sometimes be small /subtle an optical coherence tomography (OCT) scan is almost always done to confirm the diagnosis as well as to measure the size of the hole, determine its stage and predict the outcome of treatment .
Age related macular holes of stage 2 and beyond can be successfully treated with vitrectomy surgery . In this procedure, the vitreous gel from inside the eye is removed , the hole opposed and a gas bubble filled inside the eye which self absorbs in 4-6 week period . Some surgeons may recommend a face down position for the initial few days after the surgery to hasten the closure of the hole . Stage 1 holes do not need surgery but serial check ups to detect progression to subsequent stages is recommended. If the contralateral eye has developed a macular hole more frequent check ups for the normal eye may be advised . Macular holes secondary to other causes carry a poorer prognosis
Written by: Dr. Jyothsna Rajagopalan – Consultant Ophthalmologist, Coles Road
It is a hole in the central part of the retina macula
Decrease in vision is the commonest symptom
Post menopausal female have a slightly higher risk of developing macular holes
Vitrectomy surgery is the treatment and smaller holes of shorter duration have higher success rates
To ensure the gas bubble opposes the macular hole enabling its closure